In a brand new building, notable by its bright orange beams, a brand new doctor’s office is growing in popularity. 

Six days a week, Dr. Salote Vaai opens the doors to Health in her Hands and welcomes dozens of women, children (and even men) to her female health focused clinic, which she opened on the heels of Samoa’s state of emergency in March 2020.

The young doctor from Sataua Savaii set out to open her own private practice with a singular focus: to improve access to women’s health and empower women to take control of their wellbeing.

Nine months later, that vision is becoming clearer. Women are starting to visit the clinic just because, and not to treat some illness or irritation.

“A lot of them expect [to test] blood pressure, sugar, blood tests, and then they are surprised when we talk about an annual breast check for women above the age of 45, a cervical smear, and then we talk about sexually transmitted infection screenings, family planning, abnormal periods,” she explained.

“I try to give them as much information as I can in a half hour consult, and then I also tell them if someone else has the same problem, you have to point out to her that it’s not normal and they have to come in.”

Dr. Vaai said often, women over 50 are reporting bleeding and not knowing it is not normal and a sign of a problem. One of the ways she wants to overcome this is through her app, also called Health in her Hands, which is still under development.

“We have this thing of oh, it’s just happened once, let me just wait and see if it happens again. There are a lot of things that delay women from seeking help so we always try and teach women that annual screening is a thing, and we should try and get used to it.

“It’s encouraging to see our people getting more proactive with looking after themselves. We grew up in a culture where you only go to the hospital if you’re sick, not before, but we need yearly maintenance just like our cars.”

Dr. Vaai is a natural doctor, with a warm manner and a gentle smile. She said she decided to follow medicine after a lot of first-hand experiences with hospitals and doctors at a formative age. 

When she was a child she got rheumatic fever, and at age 11 had rheumatic heart disease as a result. She was often admitted to the hospital for frequent episodes, and at one point was diagnosed with congestive heart failure.

“I think that time spent in the hospital, I was looked after by some very nice doctors and very nice nurses, but also had some not so good experiences,” Dr. Vaai said.

“I think it was the not so good experiences that really made me want to do something about it when I got older.

“I knew then that the hospital is a pretty scary place for kids so I wanted to ensure that if I did become a doctor that the hospital wasn’t as scary, or that the doctors weren’t as unapproachable as I found some to be.”

She started out as a paediatrician, and even started a group called Project Paeds to liven up the children’s ward for those inside. But due to shortages in the obstetrics and gynaecology unit, she was relocated for four months. 

“I ended up staying for close to eight months, and after eight months I decided I actually really liked it, and there was more of a need there at the time.

“I decided I should stay and make a difference there.”

Now as a qualified specialist, Dr. Vaai is offering care and treatment for every aspect of women’s health from her Vailoa clinic: family planning, pregnancy and antenatal care, early childhood, menopause, sexually transmitted diseases, and cancer.

Early on, she noticed a lot of people showing up at the clinic unaware that private practice costs markedly more than the public services at the hospital. And not everyone can pay the difference.

When two women offered to leave extra money at the register when paying their own fee, Dr. Vaai realised maybe others would do the same, and she could start sponsoring these women’s fees.

That was in August. By December, around 30 people had shared health with strangers they might never meet or even know about. Many of them are regular clients, especially those with children who will happily leave the change from their $50 bill on their child’s $30 consult for the scheme.

“People know from our social media and come in and ask about it, so you know they are giving because they want to,” Dr. Vaai.

This fund is especially important because doctors often lose women if they have to refer them to another clinic or hospital or put them off getting treatment because of the price.

“Especially because some procedures are invasive, and if they are expensive too and you tell them to go and come back, because they are already hesitant there is a very high possibility they won’t come back,” she said.

One particular test fits both those criteria, and that is endometrial sampling where a biopsy of the uterus lining is taken to test for cancer. It’s something women over a certain age having irregular bleeding might need, Dr. Vaai explained. 

“The problem is it’s one of the most expensive things we do, it costs $150, but so far we have been able to do it for free for five women.”

Of those five, one test did actually find cancer, and the patient was able to get treatment both here and abroad. 

“This lady was willing to do the procedure but as soon as I told her the price she was quite worried. So I said don’t worry, someone has already paid your bill, we’ll just go ahead and do the procedure and then you can go.”

Other uses for the fund have been covering the $20 blood test fee, or even the entire consultation fee. And once it came in handy when a woman said she wouldn’t have money for her prescription for another week.

“Not only did we give her consult paid for by someone else, but we gave her $20 for her antibiotics and her cab fare to town. That’s from other people.

“No one has been offended. That was one of the things I worried about, but I think it’s the way we tell them about it. So far it has been very well received, with very grateful recipients, some very emotional recipients too.” 

Other general practitioners have said they might be keen to start a similar initiative at their practice too, Dr. Vaai said.

Through her work she has tried, and is succeeding, at building her community of patients that rely on Health at her Hands for their primary care.

It’s a mission she and other general practitioners across Samoa share: trying to alleviate the burden on the hospital by having families be more proactive with their health, and see their local clinic first.

“As with any general practice, you hope to try and build a community of the same patients, and you want to be consistent with them.

“We try and discourage the normal practice of jumping from one G.P. to the other, to the other, to the hospital, we want people getting used to having a general practice you continue to go to,” she said.

Dr. Vaai actually still goes to her childhood G.P., and so do other members of her family. 

“There is still a long way to go but we have made some significant steps in the past few years.”

As well as reducing the hospital load, having a functioning primary care system can help the national health service address public health issues before they blow up into crises.

Whatever is happening on the community level should get picked up by G.P.s at their clinics, and they can warn the hospital and Ministry of Health of it.

“We are the gatekeepers, the watchdogs of health,” she said.

“If there is anything that happens in the community, it should be picked up by GPs first and then we work with the hospital, we can’t do it on our own and the hospital shouldn’t have to do it on its own either.”